This study is part of a program of research involving health promotion for older adults and will test the effectiveness of an ankle strengthening and walking program in improving balance, ankle strength, walking speed, and falls efficacy, decreasing fear of falling, and preventing falls in elderly nursing home residents. Two specific objectives in Healthy People 2000 call for a reduction in deaths from falls and fall-related injuries and for a reduction in the number of hip fractures among older adults that will, in turn, reduce hospitalization for this condition (US DHHS, 1991). Implementation of fall prevention programs for older adults can facilitate progress toward meeting the goals set forth in this document. An NINR panel identified the need to investigate programs and strategies that will decrease the likelihood of falls in long term care settings as a priority area for research; in particular, the role of exercise in fall prevention was cited as beginning to show promise (Older Americans Report, 1994). Tinetti, an expert in falls research, has identified the need to more fully define the role of physical activity and exercise in fall and injury prevention (Tinetti, 1994). The research design is experimental using a pretest-posttest approach to evaluate changes in balance, ankle strength, walking speed, falls, fear of falling, and falls efficacy, with measures taken at baseline and again at 3 and 6 months after initiation of the intervention. Subjects (N=150) will be recruited from 10 long term care facilities and matched in pairs by fall risk score and then randomly assigned within each pair to the intervention or control group. Both groups will be assessed at baseline, 3 and 6 months following initiation of the intervention, but only the intervention group will received the ankle strengthening and walking program. The ankle strengthening and walking program will be conducted 3 times per week for 3 months. Each session, supervised by a trained research team member, will last 15 to 20 minutes. Subjects will do 10 to 15 repetitions of a heel-raising exercise, increasing resistance as strength increases. Then subjects will walk, with a research member at their side, for 10 minutes, if tolerated. Time will be increased according to individual's capabilities. At pretest, descriptive statistics will be computed for all the variables, including demographics, in order to characterize the sample and to assess the initial equivalence of the intervention and control groups. Following the posttests, descriptive statistics will again be calculated. The basic analysis to address all the hypotheses is MANCOVA. This procedure will be used to assess the effect of the intervention on the outcome variables: balance, ankle strength, walking speed, falls, fear of falling, and falls efficacy.